Healthcare Provider Details

I. General information

NPI: 1821032178
Provider Name (Legal Business Name): HAROLD A PICKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NEWPORT AVE EXT MS 12/15
NORTH QUINCY MA
02171
US

IV. Provider business mailing address

25 NEWPORT AVE EXT MS 12/15
NORTH QUINCY MA
02171
US

V. Phone/Fax

Practice location:
  • Phone: 617-246-3232
  • Fax:
Mailing address:
  • Phone: 617-246-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number79885
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number79885
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: